VR3371 Project SEARCH Progress Report - Texas
Texas Workforce CommissionVocational Rehabilitation ServicesProject SEARCH Progress Report FORMTEXT ?Instructions FORMTEXT ? Record the goals related to the services to be delivered by the Skills Trainer and Project SEARCH team; FORMTEXT ? Describe in clear and descriptive English the services provided by the Skills Trainer and/or the Project SEARCH team members leaving no blanks and enters NA if not applicable; FORMTEXT ? Record the customer’s performance as it relates to the goals addressed below; FORMTEXT ?Enter the total time spent with the customer; FORMTEXT ?Add any additional comments; FORMTEXT ?Obtain signatures; FORMTEXT ?Complete the form electronically (on the computer), making certain all questions and all applicable standards have been met before submitting by fax, encrypted email, or mailing with an invoice for payment. FORMTEXT ? FORMTEXT ?Note: Training must be in person at or away from worksite. FORMTEXT ?Customer Information FORMTEXT ? Customer’s name: FORMTEXT ?????VRS Case ID: FORMTEXT ?????Service authorization (SA) number: FORMTEXT ?????Project SEARCH Rotation Goals FORMTEXT ? Instructions: In the first column below, check Yes if the goal is identified for the customer.If the goal is selected for the customer, individualize the goal by entering Potential Areas of Focus, where indicated. FORMTEXT ? FORMCHECKBOX Yes FORMCHECKBOX NoAssist the Customer in learning skills necessary to meet the expectations of the host business site. FORMTEXT ?Skills to be addressed: FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX NoIdentify performance issues and implement a plan of action to improve the performance of the Customer. FORMTEXT ?Plan of action: FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX NoEvaluate and make recommendations for support and training needs, accommodations, adaptive equipment, and job aids to ensure safe and efficient performance by the Customer at the host business site. FORMTEXT ?Potential Areas of Focus: FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX NoEstablish support and training needs, accommodations, aids necessary to remove barriers and ensure a successful internship rotation for the Customer and host business site. FORMTEXT ?Barriers to be removed: FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX NoObserve, monitor, and make recommendations related to the Customer’s performance of tasks, use of aids, and need for accommodations to remove barriers and help the Customer have a successful internship rotation. FORMTEXT ?Potential Areas of Focus: FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX NoGradually reduce the time spent with the Customer at the host business site, as the Customer becomes better adjusted and more independent. FORMTEXT ?Potential Areas of Focus: FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX NoAdditional goals: FORMTEXT ?????Project SEARCH Rotation Progress Log FORMTEXT ? Instructions: Describe the services provided by the Skills Trainer and the Customer’s performance as it relates to the Customer’s goals. FORMTEXT ? Date Range (One week, Sunday to Saturday)Total hours of service provided for the date rangeNumber of goals addressed for the date rangeDescribe the contact made or service provided. For multiple entries, date each one.Start DateEnd Date FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total time of sessions: FORMTEXT ?????Additional CommentsAdditional comments: FORMTEXT ?????Customer Signatures FORMTEXT ?Verification of the customer’s and/or customer’s authorized representative’s satisfaction and service delivery obtained by: FORMTEXT ? FORMCHECKBOX Handwritten signature FORMCHECKBOX Digital signature (See VR-SFP 3.11.1 Documentation and Signatures) FORMCHECKBOX By sending a copy of the document returned with a scanned signature FORMCHECKBOX Unable to obtain signature, describe attempts: FORMTEXT ?????By signing below, I, the customer or authorized representative, agree with the information recorded within the report above. FORMTEXT ? If you are not satisfied, do not sign. Contact your VR counselor. FORMTEXT ?Customer’s signature:X FORMTEXT ?Date Signed: FORMTEXT ?????Customer’s authorized representative’s signature, if anyX FORMTEXT ?Date Signed: FORMTEXT ?????Provider Signatures FORMTEXT ?Skills Trainer FORMTEXT ?By signing below, I certify that: FORMTEXT ? the above dates, times, and services are accurate; FORMTEXT ?I personally completed the Progress Report collecting information about the Customer through direct services and as appropriate, the Customer’s internship mentors and Project SEARCH support team; I documented a minimum of three (3) hours each week of time spent towards addressing the customer’s goals; I personally facilitated all training, meeting all outcomes required for payment and documented the service, as prescribed in the VR-SFP and service authorization; FORMTEXT ? FORMTEXT ?Verification of the customer’s and/or customer’s authorized representative’s satisfaction and service delivery obtained as stated above; FORMTEXT ?I maintain the staff qualifications required for a Skills Trainer as described in the VRSFP or Service Authorization; and FORMTEXT ?I signed my signature and entered the date below. FORMTEXT ?Typed or Printed name: FORMTEXT ?????Signature: (See VR-SFP 3.11.1 Documentation and Signatures)X FORMTEXT ?Date Signed: FORMTEXT ?????Select all that apply: FORMCHECKBOX UNTWISE Credentialed with ID: FORMTEXT ????? FORMCHECKBOX VR3490-Waiver Proof AttachedDirector (only required for Traditional-Bilateral Contractors) FORMTEXT ?By signing below, I, the Director, certify that: FORMTEXT ? I ensure that the services were provided by qualified staff, met all outcomes required for payment, and services were documented, as prescribed in the VR-SFP and service authorization; FORMTEXT ? FORMTEXT ?I maintain UNTWISE Director credential, as prescribed in VR-SFP; FORMTEXT ? I signed my signature and entered the date below. FORMTEXT ?Director Typed or Printed name: FORMTEXT ?????Director Signature: (See VR-SFP 3.11.1 Documentation and Signatures)X FORMTEXT ?Date Signed: FORMTEXT ?????Select all that apply: FORMTEXT ? FORMCHECKBOX UNTWISE Credentialed with ID: FORMTEXT ????? FORMCHECKBOX VR3490-Waiver Proof AttachedVRS Use Only FORMTEXT ?If any question below is answered no or if the report or supporting documentation is missing or incomplete, return the invoice to the provider with the VR3460. Make a case note to document the results of the review and the date VR3460 was sent to provider, when applicable. FORMTEXT ? FORMTEXT ?Technical Review to Verify Provider Qualifications(Completed by any VR staff such as RA, CSC, VR Counselor) FORMTEXT ?Director’s Credential: FORMTEXT ?UNTWISE website or attached VR3490 verifies, for the dates of service, the director listed above: FORMTEXT ? FORMCHECKBOX maintained or waived the UNTWISE Director Credential FORMCHECKBOX did not hold a valid UNTWISE Director CredentialSkills Trainer’s Credential: FORMTEXT ?UNTWISE website or attached VR3490 verifies, for the dates of service, the Skills Trainer listed above: FORMTEXT ? FORMCHECKBOX maintained or waived the required UNTWISE Credential FORMCHECKBOX did not hold a valid UNTWISE CredentialVerification of Service Delivery FORMTEXT ?Technical Review (completed by any VR staff such as RA, CSC, VR Counselor) FORMTEXT ?Verified that the report is accurately completed per form instructions FORMCHECKBOX Yes FORMCHECKBOX NoVerified that the service(s) was provided within service date of SA and as stated in the VR Standards for Providers and/or the SA FORMCHECKBOX Yes FORMCHECKBOX NoWhen applicable, verify a copy of an approved VR3472 is attached to the report. FORMCHECKBOX NA FORMCHECKBOX Yes FORMCHECKBOX NoVerified proper recording for the date range of the start date, end date, and total hours provided during that date range FORMCHECKBOX Yes FORMCHECKBOX NoVerified the customer’s satisfaction with the training through signature on the form and/or by VR staff member contact with customer FORMCHECKBOX Yes FORMCHECKBOX NoVerified that the appropriate fee(s) was invoiced FORMCHECKBOX Yes FORMCHECKBOX NoPrint staff member(s) names who completed technical review and/or verified the UNTWISE Credentials: FORMTEXT ?1. FORMTEXT ????? Date: FORMTEXT ?????2. FORMTEXT ????? Date: FORMTEXT ?????VR Counselor Review FORMTEXT ?Verified the summary of the services the Skills Trainer provided algins with the customer's goals for each FORMCHECKBOX Yes FORMCHECKBOX NoVerified the customer received necessary accommodations, supplies and resources; various instructional approaches were used; and the customer has the ability to use compensatory techniques to increase ability to perform task and skills FORMTEXT ? FORMCHECKBOX Yes FORMCHECKBOX NoVerified that the Skills trainer used and documented on the form the FORMTEXT ?various instructional approaches to meet the customer’s learning styles and preferences FORMCHECKBOX Yes FORMCHECKBOX NoBy typing or printing your name, the VRC verifies: FORMTEXT ?completion of the technical review, FORMTEXT ?services provided met the customer’s individual needs, FORMTEXT ?services provided met specifications in the VR-SFP and on the SA, and FORMTEXT ?customer’s or legally authorized representative’s satisfaction with services received. FORMTEXT ? FORMCHECKBOX Approve to pay invoice FORMCHECKBOX Do not approve to pay invoiceVR Counselor: FORMTEXT ????? Date: FORMTEXT ????? ................
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